The Science of Diabetes Self-Management and Care

Educational messages aimed at health professionals have stressed the importance of regular eye examinations for people with diabetes and the value of early treatment. To investigate whether the messages need to be expanded or tailored in a specific way, we asked people with diabetes (N=37) to describe their reactions to the diagnosis of proliferative diabetic retinopathy and the factors that influenced their decision to seek treatment. The findings reaffirm the importance of the physician's recommendation in pursuing treatment. Furthermore, a constructive response (eg, "knew it had to be taken care of ") to the diagnosis was associated with prior knowledge of the consequences of proliferative diabetic retinopathy. Minimal racial and gender differences were observed. White women reported being influenced by the experiences of others, and African Americans reported being influenced by the diabetes educator. These findings emphasize the importance of providing patient education not only following a diagnosis but also in anticipation of probable complications.

Individuals with diabetes are at increased risk for both peripheral vascular disease and coronary artery disease. In patients with severe coronary artery disease, a cardiac assist device called an intra-aortic balloon pump (IABP) often is used to aid the failing heart and prevent further cardiac ischemia. Because this device is inserted via the femoral artery, patients are at risk of limb ischemia distal to the insertion site. Patients with diabetes are particularly prone to this complication. Detecting the early signs and symptoms of ischemia is crucial to preventing serious sequelae. Standard vascular examination techniques, in addition to being subjective and not easily reproducible, may be misleading in patients with diabetes. This article provides a review of the signs and symptoms of lower limb ischemia and noninvasive vascular tests that clinicians can use to evaluate lower extremity circulation. Also included are protocols for patient care during and after hospitalization, and two case studies of cardiac patients with diabetes who were treated with an IABP.

The use of clinical paths for patient care management was explored by this development team as a mechanism to provide consistent, high-quality care to hospitalized patients in high-volume, high-risk diagnostic categories. Reviewing the historical aspects and importance of clinical paths helped expand the team's perspective to incorporate pre-and posthospitalization phases of patient care into the clinical path being developed.

A multidisciplinary team of physicians, nurses, health educators, and dietitians from both inpatient and outpatient departments of Kaiser-Santa Teresa Medical Center in San Jose, California, devised and implemented an Adult Diabetes Mellitus care path. Staff education preceded the implementation of the care paths. Measurements of quality indicators showed improvements in patient satisfaction, patient education, patient knowledge, and nutrition assessments.

The purpose of this study is twofold. First, it provides a review of the literature supporting the development of a new service to help patients with diabetes and their providers manage their care. This service, automated voice messaging (A VM) with nurse follow-up, allows for systematic and intensive patient monitoring and diabetes education as well as a means of focusing clinical resources where they are most needed. Second, it provides a description of a prototype AVM-based diabetes management service that has been developed as part of two ongoing, randomized, controlled trials to test the efficacy of AVM care for patients with Type 2 diabetes. Preliminary findings from implementing this service in two large public healthcare systems suggest that AVM-supported care is feasible, desirable by clinicians and patients with diabetes, and may identify serious health problems that otherwise would go unnoted through standard means of clinic-based patient care.

Adequate psychosocial support is a major factor in well-managed diabetes, especially with newly-diagnosed adolescents who face many life changes. A review of the literature shows that few psychosocial support systems exist for adolescents with diabetes. Few psychosocial interventions have been tested and shown to be effective in improving the diabetes-related behavior of adolescents. The purpose of this paper is to provide an overview of the emotional and developmental needs of adolescents who are newly diagnosed with insulin-dependent diabetes mellitus and to propose a mentoring program that pairs a qualified, supportive young adult who is knowledgeable about diabetes with a newly diagnosed teenager with a similar socioeconomic background. The trained mentor will provide support to the adolescent regarding diabetes-related issues as well as other issues related to adolescence.